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FW-10-23-2569Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 13 NE 108TH ST, Miami Shores, FL 33161 1121360110420 Contacts SALIMA SAWANI Owner LLIZAN INC Contractor 13 NE 108 ST LEONARDO CABRERA Home: 3054312357 salimasawani@gmail.com 14921 SW 82 TER 3-210, miami , FL 33193 Business: 7867686978 Ilizaninc@gmail.com Description: REPLACEMENT OF EXISITING WOODEN FENCE Valuation: $ 14,855.00 Inspection Requests: ROUND BACKYARD (METAL PRIVACY FENCE 6' HIGH) 305 762 4949..; . 3 INSTALLATION OF 280' OF PRIVACY METAL FENCE Total Sq Feet: 0.00 DURA-FENCE BRONZE COLOR Fees Amount Application Fee - Other $50.00 CCF $9.00 DBPR Fee $7.56 DCA Fee $4.54 Education Surcharge $4.50 Engineer Fence Systems $454.00 Planning and Zoning Review Fee $70.00 Scanning Fee $15.00 Structural Review ($60) $60.00 Technology Fee (Manual) $50.40 Total: $725.00 Building Department Copy Payments Date Paid Amt Paid Total Fees $725.00 Cash 10/19/2023 $50.00 Credit Card 12/28/2023 $675.00 Amount Due: $0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFID IT. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating 6nstr do d zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date December 28, 2023 Page 2 of 2 Miami Shores Village Building Department 100SO N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING P � 9 C U TI OCT .19 2023 y� FBC 2VD Master Permit No7RO- «—L-2 —2 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 13 NE 108 Street City: Miami Shores County: Miami Dade zip: 33161 Folio/Parcel#: 11-2136-011-0420 Is the Building Historically Designated: Yes _ NO x Occupancy Type: Load: Construction Type: Flood Zone: _ BFE: FFE: OWNER: Name (Fee Simple Titleholder): SALIMA SAWANI Phone#: 3054312357 Address: 13 NE 108 Street City: Miami Shores State: FL Zip: 33161 Tenant/Lessee Name: Phone#: Email: salimasawani@gmail.com CONTRACTOR: Company Name: LLIZAN INC Phone#: 786-768-6978 Address: 1625 SW 66th Ct City: Miami State: FL Zip: 33155 Qualifier Name: Leonardo Cabrera Phone#: 786-768-6978 State Certification or Registration #: Certificate of Competency #: 13BS00513 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 14,855 Square/Linear Footage of Work: 280 Type of Work: ❑ Addition ❑ Alteration ❑ New 0 Repair/Replace ❑ Demolition Description of work: Replacement of existing wooden fence around backyard( Metal privacy fence 6' high) Installation of 280' of privacy metal fence (Dura-Fence) Bronze Color Specify color of color thru tile: 00 Submittal Fee $ Permit Fee $ �I;�, CCF $ q • 00 CO/CC $ Scanning Fee $ III,�� Radon Fee $ t� � DBPR $ -7• SZa Notary Technology Fee $_ Training/Education Fee $ `"t • S--b Double Fee $ . Structural Reviews $ U' Pe;, 7 —Z® • (XC�) Bond $ TOTAL FEE NOW DUE 9 (o'75 - c,C, Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. j y;rlr' Signature_ _ Signature OWNER or AGENT CONTRACTOR The foreiigoing instrument was acknowledged before me this il,dayof �1 1 I 20 by M(A�CAVNgN' , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as The foregoing instrument was acknowledged before me this j day of Cf—'1 Q �C'i' 20 _ L 3 by ,�rcCy7arzt�Zj Cct �, i-Lvi c� who is personally known to me or who has produced _ .— as identification and who did take an oath. NOTARY PUBLIC: RIJt/vl� Sign: Sign: Print: Nrk G Print: i IIMI041RES r,/' �� MY COMMISSION #�HH2O3025 Seal:_ , _ _ Seal: EXPIRES: NOV29, 2025 i►.Y ►�;.. MAYRA ALEJANORA ALEMAN °FPS Bonded through 1st State Insurance • Notary Public - State of Florida P` Commission # HH 047144 handed thrush National Notary Assn. _ APPROVED BY _ Plans Examiner Zoning VID—t 23 Structural Review Clerk g Ppitovj 12I,q4.7 OCT 19 2023 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) The undersigned Affiant, �u "'''� �'`' `'Noes hereby attest that (Property owner) The attached survey, performed by It Su vy"► V1 I n c . (Name of surveyor's company) For address: N l< v B'� (L; -zLe4 , V VV i c%� T- — Ito l Performed on & I ZS I I C1 (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Fujher, Affiant say eth u ht. Property Owner Signature SWORN TO ND SUBSCRIBED before me this 1� Affiant is personally known to me, produced Revised on 5/22/2009/ Revised on 6112/09 Property Owner Print Name day of Q C O 7"07-?j identification.as MCA N Notary =ai,A.y %`^ MAYRA ALEJANDRA ALEMAN Notary Public - State of Florida "W" e`Commission 8 HH 047144 My Comm. Expires Nov 14, 2024 Bonded through National Notary Assn. Proudly Serving Ja1 I the Florida Real ME LAND i-date C otnmitnity T :i'''° I6r Over 20 Ycars 'v WtVW.MIII.ANl)1;lRVI(7;.gAY)M Garbaqe Niche 80 SOF 12.0' ASPHALT ALLEY 75.00' (P) 4 a C (NO .ID) I CONC,! WOOD ... : (N0.lD) ...y.....y rr FENCE 28.55' K v q y 6.3' 14.40' 7.0' x 5' WOOD I „) a �( 5' WOOD FENCE WW 10.90' -- FENCE CONC POOLX DRIVE 5.1 13.0' 4ONC. 12.40' 10.2 ' t� ! ON PICONC � 2 9.2' N 19.60' 14,3 n Wow' �. o . N y I OF cd ONC V �, %3,X3 2$.20' i p U JONE STORY N -r m �' t 1.0, M RESIDENCE 9 # 13 28.20' 1.0' J w) 71LE i t. Ni 12.40' 0.45' 14,35' 5 _..N...._ � 9. 0.70' 0 4.�y - c� O C.D.S _ - .. : --�•-- °�-_._...__.. WADI. 4—CONC � e 74.73'(P) 36.0' B.00 v E31. F".1.P. ,1%2" Ft.-P:-4-1k2„ '5' CSW 75.00' (p) F.LP. 1/2APP „ g� (NO, ID) o.lp) +14�; 4• (NO. ID) o CONC MI [I - �UYRES�II��AG Cq RKS EvIEW WISV PL NNING DEPARTMENT 75'o RIGH �p3 �L�C ATE 23 IVED 1 %tHA'AAfT—`— `— -�YE:�2 �•�` N.E. �I n8th S E bPm:(:�.I aiiJ: biiliiViil. 01 ih. ,, li o Accepted By: o , Property Address: Notes: WQTj5$�, 13 N.E. 108 Street Miami Shores, FLORIDA 33161 80RVEYOR'8 CERT"'CATIDN:IHER�SY2 ?1rYTHAT THIS BOUNDARY SURVEY IS A TRUEAND M.E. Land Surveying, C Ec7 RESFN A ION(N'ATTlss!ffUf4VEYl'H�iiSjlq'EO IINDERMYDIRECTION.7HI3 COMPLIES y 9, Inc. PROFESSIONAL LA ND SURV:YTECHNICWITH THE MINIMUM TECHNIC�t�51N D��,.AyyRAMr� 22rJ-1):1J5,I THROUGH W7-052, FLORIDA H DY THE STATE Or ABOMDOP 10665 SW 190th Street , ADMINISTRATIVE CODE PURSUANT T,W7,027FLORIdA,TTATUES. Suite 3110 SIGNED tl % . FOR THE FIRM Miami, FL 33157 ME LAND JOSE ROCHE •.M Phone: (305) 740-3319 !' IFSTATE OF FL j%-n" is � r„ P.S,M. No. 5935 Fax: (305) 669-3190 NOT VAUD WITHOUT AND AUTHEN�'kW7t) tfiQ,1Rt:NIC SIGNATUREAND AUTHENTICATED � ELECTRONIC SEAL AND/OR THISMAP ISM T VAUD WITHOUT THE SIGNATURE AND THE ORIGINAL LB#: 7989 RAISED SEAL OF A LICENSED SURVEYOR AND MAPPER. Survey 11:B-58877 Client File U: 19066758 Page I of 2 Not valid without all pages FLC)RIIN FAST METAL ALUMINUMSYSTEMS4,c. GENERAL 1. ALL WOW SINLL CONFORM TO FLORIDA BUILDING CODE 2020. 2 IT IS TFf INTENT OF TFESE DPAWINGS TO BE IN Al OORDMIE W(TH APPLVEI E CODES AND AUTIrMES HAVING A R SDICTION. ANY c . DISCREPANCIES WME7N TFESE DRAWINGS AD APPUGFAE CODES %ikL BE IMMFD11TELY EIRDWfr TO TFE ATTENTION OF TFf D"NEER. 3. IT SFWU_ BE TFE CUWfTU,CTCRS BIUIY TO WU Mini ALL APPLICABLE UTILITY COWANES TO VMFY ALL UNDER- GROUND FACILITIES PRIOR TO THE BEGINNING OF CMTRUCML ALL EXCAVADONS SHAI_ PROCEED WITH EXTREME CAUTION AT ALL TWL IN TW EVENT 7l1AT EXISTING UTILITIES ARE DAMAGED, IT SHALL BE TFE RESPONSIBILITY OF THE CCNTRAM TO REPAIR OR Rt]Va ALL DWAGES. 4. DiS WORK REQUIRES A BUILDING POW. DO NOT EEDN WCRIONG UNTIL A EIUIDING PEW S OBTAINED. 5. CONTRACTOR E TO FURNISH All LABOR, MATERIALS, SERVICES AND EQUIPMENT NECESSARY TO COMPLETE ALL WPM a M ON Ttf DRAWINGS AND SPECIFIED HEREIN. 6. DO NOT SCALE DRAM NGS, DIVIDMIS GDAR N. 7. oahE Ts V15T5 TO TFf SITE, AS PER QC OR UM,ER'S R£OI.EST "NO 0ONSrRUCTICNI %lAIE BE SalEX ED VMN 24 WLFS PRIOR TD - IFSFETICK [l 8. TFE OONTRA= SWLL WE REQURED AITANtW4S, SECURE AND PAY FOR ALL BARfICADFS, DQDSURES, AND FENCING AS NEEDID FOR AND DURING TW PROGRESS TO PROTECT AD, ACE14T PROPERTIES. 9. T E CONiTyLTOR Stall NOT FROM WTrH ANY A U IONAt_ SERNCES OR WOFX MAHOUT FPoCR NOTIFICATION TO TFE GVMEP 10. TFE CONTRACTOR IS SOLELY RESPONSIBLE FOR MEANS AND WXDS COSWCT10F1, AND FOR TW SEQUENCES AND PROCEDURES TO BE USED, 11. CONTRACTOR SHALL BE RIE504318tf FOR FAMILIARIZING WfTH CI ;609 SITE CGPD@CP6. AND SILL REPORT ANY DISt:REPANCIES To TFf ENGINEER PRICK TO STARTING W MC 12 CONTRACTOR '%Nl VERIFY ALL DIME)ME AD E70SilW OaVTIONS AT TFE JOB ME. ANY DISCREPANCIES BETWEEN RAMS, SEC110F6 AND DETAILS OR TFE APPIJG@3LE CODES OR REGIAATIONS Stall. SE BROLW TO TFE ATTENTION OF 1Ff ARCHTECr OR ENGINEER DURING BIDDING OR bi-FORE WOW BEGINS IN ORDER TO CLARIFY Tit REQUIREikNIS AND TO EFFECT W NECES'SARI MODIR<ATCMa UTANCIS AND /OR INSTRUCTI061S. C it CON'r MI S1iM.L BE RMOONSIBLE FOR RESETTING ALL DISILMED DOSTIFG COFDr 06 AND PROPER DISFC A. OF ANY EXTRA MATMALS & GAR&W E FROM TFE SITE AFTER CC♦.PII" OF WAORIC. 14. DRAYANGi AND DIME)GONS ARE EASED UPON DRAWINGS Sf PPI.IED EK TW CLIENT. EASTERN EdGiNERING (;f'eoi.P MILL NDT BE RESPONSIEtE ' FOR ERtdCA'S OR WSINTERPRE.TATIONS OF Rf S15TEM DESIGNED BY US BASED ON CLIENT CONFIRMED DESIGN AND DIMEIN9DF& ADOiT LKk 1 UYARTIFG TIME BAlOYED IN TFE CI7GE OF TFE DEXN AFTER SICKING AND SEALING OF DRAWINGS MILL RESULT IN ADDITIONAL COST. 15. DO NOT SLE= MATERIALS, EQUIPMENTS OR METFE'AS OF COMSRrflON MISS 91" SU65TT1Ui 08 OR CHANGES P&I BEEN APPROYEU IN WRITItc BY T1-E 0*01 Fir MIND Li k) AS PER ASCE 7--16 i l-_3Z� MIND VELOG?Y AS P-9 ASCE 7-16 MIAMI-WE (ATE{ 0W. 2 - 115 rrph AS PER FEC202T0�S€CTTION 1616.2.1 CAL C2V L KnONS` H FBC2021JANUASCE -16 „ot•gory I L (ft): 4 2 1/2x2 I/2x16 goge steel goWnixed 200.071 at golmized IFxposure: C Hpost (ft) 6 A-500 A-500 V (mph): 115.0o A-500 Fy (psi) 46000 Mrrax. (lb -in) 13991 Mmax. (lb -in) 1166 I: 1.00 Fb (psi) 27600 Zx (in-3) 0.58 Ss (16-3) 0.124 Kd: 0.85 Fv (psi) 18400 fb (psi) Nnax/Sx fb (psi) Umax/Sx M (fl): 6 A-36 Fy (psi) 36000 fb (psi) 24132 fb (psi) W6.451613 Pd (psi): 16.2 Fb (Psi) 21600 fb (pol0b OK fb (psi)<Fb 0M. Fv (psi) I4400 i�?i-_ a:, '7!IL :,;R .'.tvtGty FC•.1 PCs ;:N .... '+: i,.,.N ,Ri.,,-. .,. _..D Adual Pullout 194.4 Using 1 ex S cw Krik Flex Scrcw p 388.80 Latefgl soil bearing 200 Allomble Pullout 200 A 1.44 Foot Oiamator ft ng ( ) 1.583 OK d I I Do For poles 1806.3 4 , r. T.. �j. ., �8,,_. PpRO\JED HADOW BOX DETAIL---` SCALE: N.T.S. O C T 19 2023 ' GALVANIZED STEEL TUBE c 1TY RAIL TOP MEMBER. • __ 7 _f 26 GA (MIN:) GALVANIZED METAL SHEET Ic P y - IJ Lj 4� 2.5x2.5x 16 GA > GALVANIZED STEEL Posy � At, SPACED 0 4'-0• MAX. 0.-Itlern 0l. 2xlx16 CA GALVANIZED E a zs STEEL TUBE Engineering GrOUP RAIL BOT. ; MEMBER. 1' 3000 PSI CONCRETE ` FLORIDA ALUMINUM SYSTEMS LLC 2023 FOOTING 012"0'-0" / DEEP OR 019"xS-0" 22-0616 00 7/1/2022 DEEP OR 024'x2'-6' MIAMI, FL DEEP (TYP). ----- ---_......_._.__...__....- - - ......... . ... -- - - _ FLORIDA ALUMINUM SYS71EMS LLC .. _� - ` _.......... FFNr E CON' -,IF _IONS:-- _..__ ... - ..._.. * RAIL TO TO BE CONNECTED WITH '2" 10--16 rtNiK MARId MORALES U . P... . - CLAUDIA FRC ENZA CWZALQ A. 'AZ_ FLEX S-R 'r'r b 1iL71 0N`, APPROVED EQUAL ACCESS 01 ` - - .-_._ YAPPLICABLE EXCLUSIVE .......... _ ............. ................... ....:_...._._ AT RAT?. TO) RE = RChIDED FOR CONNF�CT;ON, OR BE `rAJL Lei ONLY FOR Sr..ME�t1ARY " WEi1; t ``�GT t IN 2 OI'051TE 510Eti MiNiMLIM. AND FO A, i:'::1 ROCK ' CI! .. -- - -- --_ w.................. .__ • PICKETS TO BE CONNECTED TO TOP AND BOTTOM RAJLS WITH 0'2%2'-9" DEEP (*} - - ---- - (4 PER rICXET, 2 TOP & 2 BOTTOM) 10-16 KWIK FLEX - - - _._-.---_... SCREW '.:y k7ll OR APPROVED EQUAL, OR BY 1/4" PUDDLE WELDS (*) SOIL SHALL BE coeY�aiT T2VE6 ' VERIFIED TO BE `� CONSISTENT WITH _ _ z. • • I 4K(i0 A PAZ PT Ot/W SCALE: N,T.S, THE MENTIONED CHARACTERISTICS. A I sun- 4'-0' MAx. FLORIDA LICENSED ces ood Side --- --- - -- --- 1 It ENGINEER SHALL N�Litn ;rer,;U rs of a farco stiali u4u I S. ` f f 1 / VISUALLY INSPECT rr i ,,cr oT if1� P', a`i cil the 1 t is iccatt d AND PROVIDE A "i'� ,i e' firusi ieJ �i 'E Tall face the ' �--- ad:6iriirly CERTIFIED LETTER lat X Etry abutting right*f=�v?y, \ r-X4Wf'im PT A V XTFPW \ �- ATTESTING S0. SCALE: N.T.S. 4.4.6....4... S=0.124 IFY 2 7x=o.0o69 Try' Mmox=16.2*6*.5*4*4/8 S=0.0938 IN' Mmox=16.2*(6.375/12)*0.125*3.25*3.25*12 `Pik l� Mmox=136.36 #-in l M AW=Mn/0 , Mn=Fy*Z , 0 =1,67 a M ASa=148.74 1-in r Mmox < M Aso o I =1 166 #-in Mmox=16.2*6*.5*4*4/8 M Asa=Mn/0 , =116fi -in Mn=Fy*S , 0 =1.67 M iso-FbxSx, 19KSlxO.D938 in3 M .w=2 673 1-in M w=1782.2 #-in Mn10X < M ASo Mmax < M ASo .... . _. 2'_ _i _ _ 1' '� ALTERNATIVE RAILS PICKETS (26 GA) POSTS (16 GA) RAILS (16 GA) (ALUMINUM') 7/l/2022 f GONZALO_A, PAZ, PE. (Lic No 60734) CERTIFICATE OF AUTHORIZATION No 26655 NCE X-1.0 r U Z 4w w IS rn �, ° M LL ca M e t"' W o A 006031 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7173434 BUSINESS NAMULOCATION RECEIPT NO. e. EXPIRES LLIZAN INC RENEWAL SEPTEMBER 30, 2024 1625 SW 66TH CT 7452528 Must be displayed at place of business MIAMI FL 33155-1859 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT DECEIVED LLIZAN INC 196 SPECIALTY BUILDING CONTRACTOR BYTAXCOLLECTOD r'/0 LEONARDO CABRERA 13BS00613 $45.00 09/26/2023 vorker(s) 1 INT-23--470184 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ra-276. For more information, visit www.miamidade.gov/taxcollector Municipal Contractor's Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY CC NO: 13BS00513 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES LLIZAN INC 1625 SW 66TH CT 7668196 SEPTEMBER 30, 2024 MIAMI, FL 33155-1859 Pursuant to County Code Sec10-24 OWNER TYPE OF BUSINESS LLIZAN INC SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR C/O LEONARDO CABRERA 175.00 10/19/2023 INT-24-008883 This receipt is not valid in the following Municipalities: Aventura, Dora[, Hialeah, Key Biscayne, Miami Gardens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny Isles Beach, Town of Cutler Bay. M!®D For more information, visit www.miamidade.gov/taxcollector ®® CERTIFICATE OF LIABILITY INSURANCE DATE ( YYYY) 10/19/2023/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE (855) 222-5919� FAX _(ALC No Ext): (A/C,,No): Next First Insurance Agency, Inc. PO BOX 60787 Palo Alto, CA 94306 ADDRESS: support@nextinsurance.com ADDRESS: ..__ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: State National Insurance Company, Inc. 12931 _ INSURED INSURER B : Llizan, Inc.- 1625 SW 66th Ct INSURER C : INSURER D: Miami, FL 33155 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:066876595 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER Yk POLICYNUMBER POLICY EFF MMIDDIYYY POLICY EXP MM/ODNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS -MADE IJ OCCUR DAMAGE PREMISES Ea occurrence) $100,000.00 MED EXP (Any one person) $15,000.00 _ PERSONAL & AOV INJURY S1,000,000.00 A X NXTLY3WKJ3-01-GL 04/14/2023 04/14/2024 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000.00 $2,000,000.00 X POLICY PRO E] JECT LOG -PRODUCTS _ $ OTHER: AUTOMOBILE LIABILITY CEaOMaccideBINEDnt) SINGLE LIMIT $ BODILY INJURY (Per person) - S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accldenl $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN ANYPROPRIETOR/PARTNER/EXECUTIVE Y I STATUTE ER _- E.L. EACH ACCIDENT _ S E.L. DISEASE • EA EMPLOYEE $ OFFICERWEMBEREXCLUDED? (Mandatory In NH) N/ A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below Each Occurrence: $25,000.00 A Contractors Errors and Omissions X NXTLY3WKJ3-01-GL 04/14/2023 04/14/2024 Aggregate: $50,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES (ACORD 101, Additional Romarks Schedule, may bo attached If more space is required) The Certificate Holder is Miami Shores Village Hall Building & Zoningg. This Certificate Holder is an Additional Insured on the General Liability policy per the Additional Insured Automatic Status Endorsement. General Liability coveragge applies for Fence and Gate Installation operations in Florida. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and tfie insured, and are subject to policy terms and conditions. CC13BS00513 rrcori=ir`ATF urm nGa CANCFI 1 ATInN Miami Shores Village Hall Building & Zoning LIVE CERTIFICATE 10050 Northeast 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. . Click Or scan t0 VieW AUTHORIZED REPRESENTATIVE (/ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 11/19/2023 PERSON: LEONARDO CABRERA FEIN: 463037952 BUSINESS NAME AND ADDRESS: LLIZAN, INC. 1625 SW 66TH CT MIAMI, FL 33155 EXPIRATION DATE: 11/18/2025 EMAIL: LLIZANINC@GMAIL.COM This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT E01793696 QUESTIONS? (850) 413-1609 RULE 69L-6.012, F.A.C. REVISED 01/2023 � � � � � T � pC�1 9 2023 Miami shares Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Nonce IO uwner — WOrKers" uorllpensation insurance Exemption Florida Law requires Workers' Compensation insurance coverage Linder Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this �� day of M, 20 1 . By SCk t MCA �\NC, N who is personally known to me or has produced as identification. f, i ,11�, sOL� u� '-. MAYRA ALEJANDRA ALEMAN ?t'.1 `� Notary Public - State of Florida o< Commission N HH 047144 '' of rr ` My Comm. Expires Nov 14, 2024 bonded through National Notary Assn. LLIZAN INC. 1625 SW 66th CT Miami FL 33155 Tel:786-768-6978 Date:10/18/2023 State of Florida County of Miami -Dade Before me this day personally appeared Leonardo Cabrera deposes and says: HHU T OCT rszo23 F who, being duly sworn, That he or she will be the only person working on the project located at: 13 NE 108 Street Miami Shores FL 33161 ContrMfor Signature Sworn to (or affirmed) and subscribed before me this /1 day of by � ����'� �Q61-ems l/G / U� X"- Personally know 20Z, OR Produced Identification FG /DZ— Type of Identification Produced fZ d�- Print, Type or Stamp Name of Notary